Anti-TNF-induced remission in very early peripheral spondyloarthritis: the CRESPA study

Carron, Philippe; Varkas, Gaëlle; Cypers, Heleen; Praet, Liesbet Van; Elewaut, Dirk; Bosch, Filip Van den

doi:10.1136/annrheumdis-2016-210775

Cited by 59 publications

(38 citation statements)

References 26 publications

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“…Proportion of patients achieving a status of clinical remission, major response, and nonresponse. The results of the first 24 weeks, a double‐blind placebo‐controlled phase, have already been reported . Forty‐nine of the 60 patients (82%) achieved the status of sustained clinical remission at week 48 (Figure A), the majority of whom had already achieved this status at week 24 (n = 30), with an additional 11 and 8 patients at weeks 36 and 48, respectively (Figure B).…”

Section: Resultsmentioning

confidence: 82%

“…It corroborates and extends our earlier results that initiation of TNF blockade in very early peripheral SpA yields remarkably high rates of clinical remission. In contrast, substantially lower responses are observed in patients with more established forms of the disease . Importantly, the lack of a significant response in placebo‐treated patients ruled out the possibility of spontaneous remission.…”

Section: Discussionmentioning

confidence: 99%

“…Patients. All included patients were adults newly diagnosed as having active peripheral SpA and fulfilling the Assessment of SpondyloArthritis international Society (ASAS) criteria for peripheral SpA . Active disease was defined as the persistent presence of arthritis, enthesitis, and/or dactylitis and by a visual analog scale (VAS) score of ≥40 mm on both the patient's global assessment of disease activity and the patient's global assessment of pain at both the screening and baseline visits.…”

Section: Methodsmentioning

confidence: 99%

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High Rate of Drug‐Free Remission After Induction Therapy With Golimumab in Early Peripheral Spondyloarthritis

Carron

Varkas

Renson

et al. 2018

Arthritis & Rheumatology

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Section: Resultsmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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High Rate of Drug‐Free Remission After Induction Therapy With Golimumab in Early Peripheral Spondyloarthritis

Carron

Varkas

Renson

et al. 2018

Arthritis & Rheumatology

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“…In einer großen doppelblinden randomisierten Placebo-kontrollierten Studie bei insgesamt 313 Patienten mit aktiver Psoriasis-Arthritis fand sich bei den 118 Patienten, die auch eine Enthesitis hatten, eine Verbesserung der Enthesitisregionen über zwei Jahre, erreichte aber nach 24 Wochen keine Signifikanz (56). In einer Studie mit Golimumab bei sehr früher peripherer SpA zeigte Golimumab gegenüber Placebo eine signifikante Überlegenheit bezüglich des Maastricht-Enthesitis-Scores (57).…”

Section: Mrtunclassified

Druckschmerzhafte Körperstellen – Enthesitis?

Haibel¹

2018

Arthritis und Rheuma

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ZusammenfassungDie Enthesitis ist eine häufige Manifestation bei Spondyloarthritiden (SpA) und Psoriasis- Arthritis (PsA) und tritt bei bis zu 40 % der Patienten mit SpA auf. Wegen ihrer pathognomonischen Bedeutung ist Enthesitis in verschiedenen Klassifikationskriterien für SpA und PsA als ein Eingangs- oder Nebenkriterium aufgenommen worden. Häufigste Lokalisation ist die Ferse, aber Enthesitiden können ubiquitär an Sehnenansätzen in den Knochen auftreten. Bei der Diagnose der Enthesitis sind zahlreiche Differenzialdiagnosen zu beachten, insbesondere sollten mechanisch-degenerative Ursachen unterschieden und eine Fibromyalgie ausgeschlossen werden. Als bildgebende Verfahren sind der Power Doppler Ultraschall (PDUS) und die Magnetresonanztomografie (MRT) besonders diagnostisch hilfreich. Die therapeutischen Optionen bei Enthesitis sind begrenzt. Es werden die Gabe von nichtsteroidalen Antirheumatika und lokale Steroidinjektionen empfohlen. Während in kleineren Studien für Disease Modifying Antirheumatic Drugs keine Wirksamkeit gezeigt werden konnte, haben sich TNF-alpha-Blocker, Anti-IL-17-, Anti-IL-12/23- sowie Anti-IL-23-Antikörper in randomisierten kontrollierten Studien sowohl bei SpA als auch/oder bei PsA als effektiv erwiesen. Sie sind jedoch derzeit nicht für die Therapie einer alleinig vorliegenden Enthesitis zugelassen.

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“…However, the important limitation of this study was the open-label design and these data have not yet been confirmed in a placebo-controlled setting in PsA. Exploring the same concept in a slightly different population, Carron et al investigated the early initiation of TNFi treatment in a placebo-controlled study in a mixed population of patients with early peripheral spondyloarthritis, of which 40% had concomitant nail or skin psoriasis 19. Patients achieved clinical remission (defined as absence of arthritis, enthesitis and dactylitis) in 75% in the TNFi-treated arm versus 20% in the placebo arm.…”

Section: Introductionmentioning

confidence: 99%

Achieving remission in psoriatic arthritis by early initiation of TNF inhibition: a double-blind, randomised, placebo-controlled trial of golimumab plus methotrexate versus placebo plus methotrexate

et al. 2019

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ObjectivesEarly initiation of effective treatment favours remission in rheumatoid arthritis, but it remains unknown if the same concept applies to psoriatic arthritis (PsA). Therefore, this study investigated whether the combination of golimumab plus methotrexate (MTX) as a first-line treatment is superior to MTX alone in inducing remission in PsA.MethodsThis investigator-initiated, multicentre, double-blind, randomised, placebo-controlled trial included 51 MTX and bDMARD-naive patients with PsA fulfilling the CASPAR criteria and with active disease at baseline (≥3 swollen joint count/tender joint count). Patients were randomised to golimumab (50 mg SC monthly)+MTX (n=26) (TNFi arm) or matched placebo+MTX (n=25) (MTX arm). MTX was started 15 mg/week and increased to 25 mg/week over 8 weeks. The primary endpoint was percentage of patients achieving Disease Activity Score (DAS) remission (<1.6) at week 22. Safety was assessed throughout the study.ResultsThe primary efficacy endpoint was achieved by 81% in the TNFi arm versus 42 % in the MTX arm (p=0.004). This difference in DAS remission was already observed at week 8. A significant difference in favour of the golimumab+MTX arm at week 22 was also observed for other response criteria such as MDA, ACR20/50/70, disease measures and patient-reported outcomes. The occurrence rates of adverse event and treatment-emergent adverse event were similar in both arms.ConclusionsIn patients with early PsA, DAS remission at week 22 was almost doubled with golimumab+MTX versus MTX alone. This double-blind, randomised, placebo-controlled study supports the concept that early initiation of TNFi in patients with PsA favours remission.Trial registration numberNCT01871649.

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Anti-TNF-induced remission in very early peripheral spondyloarthritis: the CRESPA study

Abstract: NCT01426815; Results.

Cited by 59 publications

References 26 publications

High Rate of Drug‐Free Remission After Induction Therapy With Golimumab in Early Peripheral Spondyloarthritis

High Rate of Drug‐Free Remission After Induction Therapy With Golimumab in Early Peripheral Spondyloarthritis

Druckschmerzhafte Körperstellen – Enthesitis?

Achieving remission in psoriatic arthritis by early initiation of TNF inhibition: a double-blind, randomised, placebo-controlled trial of golimumab plus methotrexate versus placebo plus methotrexate

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